Future Hospital - More Than a Building

8/18/2019 Future Hospital - More Than a Building

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Future hospitalMore than a building

The Royal College of Physicians’

five-point plan for the next government

September 2014


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More than a building

Medical specialist doctors – physicians – and their teams work

with millions of patients every year. They provide expert care

to older people with dementia, to those living with lifelong

conditions and to people with a one-off illness. They work in

hospital wards, emergency departments, outpatient clinics and

into the community. Hospitals also deliver essential research

and training for the next generation of doctors, so that futurepatients receive high-quality care.

The number of people with dementia will double in thenext 40 years.1 Alzheimer’s Society

National leaders have a key role to play in addressing the

challenges facing health and healthcare, and shaping national

and local debate. The Royal College of Physicians (RCP) asks all

politicians, parties and the next government to commit publicly

to a health service that is free at the point of need, with policy

and funding decisions driven by the needs of patients.

Politicians, parties and the next government must committo a health service that is free at the point of need.Royal College of Physicians

The RCP calls on all political parties to consider our five-point

action plan ahead of the next general election:

1 remove the financial and structural barriersto joined-up care for patients

2 invest now to deliver good care in the future 3 prioritise what works in the NHS and improve

what doesn’t

4 promote public health through evidence-basedlegislation

5 adopt the Future Hospital model as a templatefor service redesign.

What the RCP does

Everything we do at the RCP aims to improve patient care and

reduce illness. Our 30,000 members worldwide work in hospitals

and the community across 30 different medical specialties.

They care for millions of patients with a huge range of medical

conditions, including older people and those with lifelong

illnesses. We ensure our members are educated and trained to

provide high-quality care, then support them in providing that

care with our evidence-based clinical guidelines and education

and leadership programmes.

We audit and accredit clinical services against national

guidelines, and provide resources for our members to assess

their own services. We involve patients and carers in every

aspect of our work, and partner with other medical royal

colleges and health organisations to drive health improvement

and quality in medicine. We also have a wider duty to reduce

preventable illness from causes like smoking and drinking, and

promote evidence-based policies to government to encouragehealthy lifestyles.

The RCP – improving the care of the individual patient and the

health of the whole population.

Delivering the future hospital

Care should come to the acutely ill patient, rather thanthe patient being moved around the hospital.Future Hospital Commission

In 2013, the RCP’s independent Future Hospital Commission

set out a radical model for the future of health services. 2 Thisimportant vision set out how hospital services can adapt to meet

the needs of patients, now and in the future. The RCP is working

directly with individual hospitals and partners to develop this

vision and achieve real change across health and social care.

Politicians can support us by promoting the Future Hospital

model in national and local discussions about the design of

health services, and removing barriers to delivery.

Jane Dacre

President of the RCP

More than a buildingHospitals are more than bricks and mortar: they are a part of the local

community, delivering expert care far beyond hospital walls. Everyone shouldbe supported to be well, and have access to high-quality care when they

are ill. Future hospital: More than a building sets out how government and

politicians can make this vision a reality.

© Royal College of Physicians 20142


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The RCP’s five-point planKeeping people well and providing safe and expert care

We call on government andpoliticians to:

1 Remove the financial and structural barriers to joined-up care for patients

It should be easier for hospitals, GPs and social care teams to

work together than separately. Financial incentives must help,

not hinder, patient care. Shared outcomes should be the norm.

Fines that target one part of the system – such as penalties

when patients are readmitted to hospital – should be removed.

Quality must always be valued over competition. There should

be an urgent review of the barriers to teams working together,

including the role of large-scale tendering of health servicesin England.

2 Invest now to deliver good care in the future Our hospitals are under-resourced and under pressure.

A crisis in care can only be avoided by a significant increase

in health funding. Healthcare costs are rising, and improved

efficiency and reconfiguration will not deliver the savings we

need to balance the books. Investing now will help us save in

the long term. Transition funding should be set up to support

hospitals and care partners as they transform the way they

deliver care. To provide excellent care for patients in the future,

government must invest in medical education and support

research. Training the next generation of doctors must be partof all health service planning and delivery.

3 Prioritise what works in the NHS and improve what doesn’tThere must be no ‘big bang’ change to national NHS

structures. Government must focus on long-term change

that delivers joined-up care for patients. A ‘10-year vision’

should set the tone for all spending and policy decisions.

Difficult decisions need to be made about the design of

services. Change should be patient centred and clinicians

must be listened to and allowed to lead. Evidence should drive

policymaking. National support for clinical leadership and

quality improvement schemes will support this. Politicians must

promote informed public debate on local health services.

4 Promote public health through evidence-based legislation Government must support local prevention and recovery

services combined with national leadership on public health,

social disadvantage and inequality. National levers – like

legislation – should be used where there is evidence to

support their use, such as: for smoking, the introduction of

standardised packaging; for excessive alcohol consumption,

the introduction of a minimum unit price for alcohol of 50p

per unit; and for obesity, taxes on sugary soft drinks.

5 Adopt the Future Hospital model as a template forservice redesign

Government and politicians should support the

development of the Future Hospital3 model, nationally andin constituencies. The Future Hospital model should be the

template for hospital service redesign. Barriers to accessing

early expert care must be removed. Specialist medical care

should reach from wards into the community. Swift access

to expert diagnosis and treatment improves outcomes for

patients and can result in long-term savings. Supporting

patients to recover and manage their conditions must be

a priority in all policies.

70% of the NHS budget in England is spent on caringfor people with long-term conditions.4

House of Commons Health Committee


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The RCP supports a model of care thatpromotes health and well-being, valuespatient experience, and is coordinated aroundpatients’ medical and support needs. It shouldbe easier for hospitals, GPs and social careteams to work together than separately.

Specialist medical care should not be limited by hospital walls, but

should reach out to patients wherever they are. GPs, community

and social care teams should be supported to reach into the

hospitals to help people return home. We must change the way we

provide healthcare, and fix financial and management structures sothat greater priority is given to collaboration and patient experience.

Doctors and local leaders cannot do this alone.

Government must remove barriers to joined-up care. Quality and

collaboration must always be valued over competition. Financial

incentives must help, not hinder, patient care. Shared outcomes

should be the norm, and fines that target one part of the system

– such as penalties when patients are readmitted to hospital –

should be removed.

We know the knee bone’s connected to the thigh bone – why is it so difficult to grasp that care needs to be joined up too? Patient

We call on the next government to removebarriers to joined-up care:

> Review barriers to collaborationValue quality and collaboration over competition.

There should be an independent review of the current barriers

to collaboration. In England, this should include a review of:

the Office of Fair Trading’s role in NHS mergers; the impact

of tendering on the provision of joined-up care, particularly

for people with chronic conditions; and the extent to which

the duties of the Health and Social Care Act 2012 to provide

services in an integrated way are being fulfilled.5

> Promote joined-up leadershipMandate the involvement of patients and representatives

from other parts of the health and care system in high-level

decisions. Bodies that plan and provide care do not operate

in isolation. Greater cross-representation will promote

understanding and improve the organisation of care. In

England, the RCP calls on the government to:

• Mandate GP representation on hospital and trustboards.

• Increase secondary care involvement in serviceplanning. People with knowledge of secondary care should

be represented in new structures introduced by the Health

and Social Care Act, including health and well-being boards.

There should be ongoing support to develop the new roles

introduced by the Act, such as secondary care doctors on

clinical commissioning group governing bodies.

• Promote understanding of new structures.Government must promote understanding of the

functions and accountability of new bodies such as clinical

commissioning groups.

> Promote innovative models of integrationGive local communities flexibility to develop radical new

models of joined-up care for patients. This should be

supported by evaluation of what works in different local

circumstances.

> Make shared outcomes the norm Actively promote shared outcomes that span their local

health and care economy in government health policies.

This should be reflected in the national mandate to NHS

England. Many patients’ long-term health is dependent on

a range of providers rather than the performance of a singleorganisation.

> Use payments to drive collaboration Join up financial incentives across secondary, primary,

community and social care. Incentives should encourage

prevention, early intervention and coordination. Reforms to

payment systems must be introduced in a phased manner to

provide stability and assess viability. In the immediate term,

the RCP calls for:

• removal of 30-day readmission penalties • adjustment to the threshold of the 30% marginal rate

for emergency admissions

• transparency in how retained funds are reinvested.

> Make payments patient centredReflect costs of delivering complex care and joined-up care in

payments. Government should:

• Pay for care over a longer period. Expand the ‘year ofcare’ model to encourage focus on long-term outcomes for

patients.


1 Remove the financial and structuralbarriers to joined-up care for patients


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• Pay for patients’ whole care package. Increase the useof ‘whole care tariffs’ for chronic conditions to encourage

joined-up care.

• Remove barriers to providing care in different settings.Ambulatory care allows patients who attend hospital

in an emergency to return home on the same day, with

structured follow-up care. However, currently there are oftenfinancial incentives to admit patients to hospital rather than

to provide ambulatory care.

> Use information to revolutionise careMake a national commitment to promoting the adoption

of electronic patient records based on common record

standards. This would improve care for individual patients,

increase understanding of how the system operates, and

enable the development of more sophisticated ways of

measuring outcomes and targeting payments.

Care shouldn’t be designed according to how the money

flows. It should be driven by what patients need, andsupported by financial structures.Hospital consultant

A shared vision for the health service

Values of the NHS

> Make a public commitment to the valuesof the NHSThis commitment should be reiterated in the first

100 days of government and embedded in policy.

Make a public commitment to a health service that:

• is free at the point of need

• is driven by patient need and supported by financial

incentives

• values collaboration and quality over competition.

Principles of the health service

> Make a manifesto commitment to the principles ofthe health serviceThis commitment should be reiterated in the first


All parties should sign up to a system in which:

1 patients’ basic needs are always met

2 patient experience is valued

3 patients:

- know who is responsible for their care

- are actively involved in decisions about their care

- are supported to self-care

- have timely access to appropriate and effective

care, across 7 days

- receive coordinated services tailored to their needs

- receive care in settings that best meet medical and

support needs

- have an individual care plan focused on recovery orwishes at end of life

4 staff are supported to care, improve and lead

5 all are supported to lead healthier lives.

Principles of service redesign

> Make a manifesto commitment to the principlesof service redesignThis commitment should be reiterated in the first


Service redesign should be driven by individual and

community needs. Politicians and policymakers should

support service planners, managers and professionals tomake this a reality. Four good practice principles should

be promoted across the system, and be at the heart of all

design and redesign of health services:

• Do services deliver continuity of care?

• Do services deliver care that is patient centred,

compassionate and holistic?

• Do services deliver for patients who are vulnerable or

have complex needs?6

• Have patients and professionals been meaningfully

involved in design?


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Our hospitals are under-resourced and underpressure. A crisis in care can only be avoidedby a significant increase in health funding.Healthcare costs are rising, and improvedefficiency and reconfiguration will not deliverthe savings we need to balance the books.

Investing now will help us save in the long term. Establishing a new

transformation fund would help hospitals and care partners to

transform the way they deliver care. Providing disjointed care for

patients is inefficient. It leads to unnecessary hospital admission,

increased lengths of stay in hospital, and delays in diagnosis,treatment and recovery. When hospital beds are scarce and staff

are stretched, patients are shunted around wards. Investing in

capacity and staff health and well-being will support patients to get

better quicker. Investing in research and medical education now will

help to develop innovative new treatments and technology, and

improve the way we care for patients in the future.

We call on the next government to investnow to deliver good care in the future:

> Increase health service fundingIncrease health funding to reflect increasing costs anddemands. If current trends continue, NHS spending as a

proportion of GDP will fall to 6% by 2021 – its lowest level

since 2003.7 Improved efficiency alone will not deliver the

savings we need – a recent Commonwealth Fund study

ranked the health system in the UK as the most efficient

amongst 10 health economies, including the USA and

Australia.8 More than a quarter of NHS trusts in England are

already in deficit. A crisis in care can only be avoided by a

significant increase in health funding. The level of funding is a

political choice and has impacts on the level of care available

to patients.

The bill for treatment of long-term conditions will requirethe NHS to find £4 billion more each year by 2016.3 House of Commons Health Committee

> Invest in transformationSet up a transformation fund to support new ways of

delivering services. Additional financial support will keep

necessary services going while new models of care are developed.

The fund should be available in every health economy to drive

investment in and movement to models of care that will lead

to more efficient, integrated care in the future.

If we don’t change the way we deliver services, there willbe a funding gap of £30 billion by 2020/21.9 NHS England

> Build capacityPublicly support a maximum bed occupancy of 85%. Current

bed occupancy rates are often greater than 90%, and

investment is needed to change this. When hospital beds are

scarce and staff are stretched, patients are shunted around

wards and less likely to get better. Patients should be able to

receive care in the place where their needs can best be met –

not the only available bed.

Two-thirds of physicians think current medical staffinglevels are having a negative effect on patient care.10 Royal College of Physicians

> Prioritise medical education and trainingMake medical education and training a priority when

designing health services. Good care in the future depends

on good training now. There should be a review of existing

service planning and commissioning arrangements to ensure

that they do not threaten the sustainability of the medical

workforce. In England, this should include a review of the

extent to which statutory duties to promote and secure

education and training are being met.11 Government should

publicly support hospitals to allow time to train and examine.

Local planning should be complemented by a national system

of medical workforce planning.

> Make research a priorityInvest in research and innovation, locally and nationally.

There should be national investment in innovation and new

technologies, like medical genomics. Such innovations have

the potential to revolutionise care and position the UK as

a world leader. To support this, academic and translational

research should be considered when planning and delivering

health services. Hospitals should be publicly supported to build

a culture of research and allow their staff time for research.

Systems should be set up to require mandatory reporting of

research findings to share intelligence. Measures should be put

in place to increase patient involvement in setting research

priorities, and large-scale participation in research.

> Invest in staffMake staff health and well-being a national policy and

delivery priority. National measures to improve patient safety,

outcomes and experience should be complemented by

measures to improve staff well-being and engagement. Staff

engagement and well-being are associated with improved

patient care and better patient experience,12–14 including

reduced MRSA infection rates and lower mortality.15 Staff

with manageable workloads have more time to care for

individual patients. Government should support a review into

the demands on the medical workforce, and promote national

sharing of good practice.


2 Invest now to deliver goodcare in the future


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The NHS needs to change and adapt to meetthe needs of patients. Government must focuson long-term change that delivers joined-upcare for patients. This means avoiding ‘bigbang’ change to national NHS structures.

Transformation will take time, long-term planning and investment,

but is essential if we are to meet the immediate pressures and long-

term challenges facing the health service. A ‘10-year vision’ should

set the tone for all spending and policy decisions.

Difficult decisions need to be made about the design of services.

Politicians must promote informed public debate on local healthservices. Change should be patient centred and clinicians must be

listened to and allowed to lead. Evidence should drive policymaking.

National support for clinical leadership and quality improvement

schemes will support this.

In the last 40 years, the NHS in England has beenreorganised once every 2–4 years.16 King’s Fund

We call on politicians and the nextgovernment to prioritise what works in theNHS and improve what doesn’t:

> Don’t reorganise, transformFocus on transformation, not national reorganisation.

The next government should avoid ‘big bang’ change

to national NHS structures, and focus on achieving long-

term transformation. National-level, top-down structural

reorganisation can hinder services’ ability to shape

themselves around patient needs. With each centrally driven

reorganisation, local leaders and professionals have to rebuild

relationships across organisational and professional divides.

> Develop a long-term planUse long-term planning to create stability and support

transformation. Transformation requires investment and stability.

Government should work to build a national, 10-year, cross-party

vision for the health service. To achieve savings in the longer term,

government must move to a longer planning cycle. Policies and

spending decisions should be accompanied by a ‘10-year’ impact

assessment. All spending decisions should be underpinned by a

long-term objective to increase alignment between health and

social care budgets.

> Don’t stand in the way of change

Promote informed debate on service redesign, nationally andlocally. Politicians should support clinically led, evidence-based

change that will deliver better care for patients. Patients

and clinicians should drive service design. To support this,

there should be more stringent requirements placed on

public bodies to consult citizens. A review should identify

current barriers to service redesign and reconfiguration, make

recommendations and share existing good practice.

> Share what worksEstablish a national programme for sharing good practice.

The NHS wastes too much energy reinventing the wheel.

National government must support new mechanisms and

networks for sharing good practice across the system. Thiswould improve patient care, increase efficiency and support

informed local variation.

> Harness clinical leadershipPromote clinical leadership and clinically led quality

improvement projects. The next government should provide

public and financial support for professionally led quality

improvement projects and leadership work. Such schemes

drive up quality and offer patients and carers, politicians,

policymakers, service planners, providers, commissioners

and regulators a robust badge of quality. Investigation of

which improvement strategies work best, a concept known as

improvement science, has the potential to transform the NHS.

3 Prioritise what works in theNHS and improve what doesn’t


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We need to build a health and care systemthat focuses on preventing ill health andpromoting wellness, rather than just treatingillness. Physicians and medical teams havea key role to play, not only in managing illhealth, but also in supporting people tolead healthier lives. Harnessing the skillsand expertise of hospital doctors across thesystem can help to build a healthier future for

individuals, communities and the UK.Politicians and government must show national leadership

on public health. This means supporting local prevention and

recovery services and taking strong national action to prevent

the damage caused by smoking, excessive alcohol consumption,

obesity, social disadvantage and inequality. National levers –

such as legislation – should be used where there is evidence

to support their use. This includes: introducing standardised

packaging for cigarettes to reduce the harm caused by smoking;

introducing a minimum unit price for alcohol of 50p per unit to

reduce alcohol-related harm; and exploring the use of taxes on

sugary soft drinks to help combat obesity.

We call on the next government to lead onpublic health:

> Strengthen public health leadershipCommit to independent and authoritative leadership in

public health.

• Give public health leaders independence andauthority. Public health professionals across the system

should be able to hold national and local decision-makers

to account when their decisions impact negatively on the

population’s health.

• Build political and professional coalitions onmajor public health challenges, including air quality,sustainability and climate change.

• Regulate industry involvement in policymaking.Conflicts of interest must be declared and avoided, and

regulated industry (eg tobacco and alcohol companies)

must not shape policy direction and decisions.

> Show national leadership on inequalityCommit to joined-up, national action on health inequality

by introducing a new health impact duty. There should be a

mandatory requirement for ministers to consider the health

impact of policies and decisions. There should be specific focus

on the potential impact on access to healthcare and disparity in

health outcomes. Expertise in healthcare and public health will

support these assessments and promote best value, effective

investment and prioritisation and a population health approach.

Measures to promote better care for vulnerable people, including

homeless people, should be supported at national level. This

should include measures to promote parity of esteem between

physical and mental health.

Each year, health inequalities cost the English taxpayermore than £5.5 billion in additional NHS healthcarecosts. Between 1.3 and 2.5 million extra years of life arelost each year as a result of people dying prematurelyas a result of health inequalities.17 The Marmot Review

> Take national action on tobaccoIntroduce standardised packaging for cigarettes and a ban on

smoking in cars when children are passengers.

• Introduce standardised packaging for cigarettes. TheRCP urges the government to implement standardised

packaging as quickly as possible. In England, enabling

legislation was included in the Children and Families Act.

• Introduce a ban on smoking in cars when children arepassengers. The RCP urges the government to implement

the ban as quickly as possible. In England, enabling

legislation was included in the Children and Families

Act. Smoking results in around 40 sudden infant deaths

in the UK each year,18and there is a strong link between

childhood exposure to second-hand smoke and asthma,

chest infections and bacterial meningitis.

Passive smoking causes around 9,500 hospitaladmissions in the UK every year.18 Royal College of Physicians

> Take national action on alcohol• Introduce a statutory minimum unit price for alcohol

of 50p per unit.

A minimum unit price of 50p per unit would target the

heaviest drinkers. The heaviest drinkers currently pay only

33p/unit of alcohol, with some high-strength ciders costing

the equivalent of only 6p/unit. The impact of minimum

unit pricing on low-risk drinkers is negligible – the average

low-risk drinker already pays around £1/unit of alcohol.19

• Develop a national, evidence-based alcohol strategy.This should be based on Health First: An evidence based

alcohol strategy for the UK ,20 and cover drink-driving and

alcohol marketing.

• Increase local powers to combat alcohol-related harm.Give councils the power to consider public health when

making alcohol licensing decisions.


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In 2010, alcohol was 48% more affordable than in 1980.20

University of Stirling

> Take national action on obesityExplore taxes on unhealthy foods; develop a national

obesity strategy . Poor diets contribute significantly to theonset of heart disease, type 2 diabetes and some types of

cancer. Diets high in fat, sugar and salt and low in fruit and

vegetables account for around 30% of all coronary heart

disease, and 5.5% of all cancers in the UK are linked to excess

body weight.21 By 2050, the majority of the population in

Britain will be obese.22

• Explore the use of taxes on unhealthy foods. Thisshould start with sugary soft drinks, both as a lever to

support behaviour change and as a means for raising

revenue for health promotion. Legislative measures have

already worked in other European countries.*

• Develop a national, evidence-based obesity strategy.This cross-governmental obesity strategy should have

a single point of contact responsible for overseeing its

implementation across government. Develop a patient

charter for those with obesity-related conditions.

• Introduce multidisciplinary weight managementclinics. There is a strong case for clinics for those with

severe and complex obesity to be centrally commissioned

and funded. Use of a patient charter for those with

obesity-related conditions will support this.

Almost two-thirds of adults and a third of children areoverweight or obese.26 Information Centre

> Join up prevention, treatment and support servicesPlan prevention, treatment and support services holistically.

Where prevention, treatment and support services are planned

separately, partners must work together. National incentives for

prevention and treatment should be aligned. In England, new

commissioning arrangements mean that some services – such as

sexual health services – are commissioned by a range of bodies.

These arrangements must be monitored to ensure that they

are holistic and joined up, whoever takes lead responsibility for

commissioning or delivery.

> Fund prevention and treatment

Increase investment in treatment and prevention programmesby reinvesting revenue from the sale of alcohol, tobacco and

high-sugar products. We need to increase investment in alcohol

treatment services. A proportion of tobacco and alcohol

duty should be reinvested into preventative and treatment

programmes. A proportion of the VAT on soft drinks, fast food

and confectionery should be reinvested into obesity prevention

programmes.

*In French schools, food and drink are controlled and all marketing of foods high in fat, sugar and

salt is banned unless they are taxed and marketed with a health warning. Studies have shown

that, following these measures , the number of overweight children in France dropped from 18.1%

in 2000 to 15.5% in 2007. (Data presented by the French Ministry of Health at the International

Congress of Nutrition, Bangkok, October 2009.)

Future hospital More than a building


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The needs of people in the UK have changedsubstantially since the NHS was set up in1948. We’re living for longer, and morepeople are living with lifelong conditions. In2013, the RCP’s independent Future HospitalCommission set out a radical vision for howthe health service can meet these challenges.2

Government and politicians should support the development

of the Future Hospital model, nationally and in constituencies.

The Future Hospital model should be the template for hospital

service redesign.

The number of people with three or more long-termconditions is predicted to increase by 1 million in10 years.24 NHS Outcomes Framework

Patients should have access to the care they need, when they

need it. Many patients can be managed well in primary care,

but most will need specialist help at some point. Some people’s

needs may be met by delivering specialist care in new ways

into the community. However, being admitted to hospital will

be essential for others. Barriers to accessing early expert care

must be removed. Specialist medical care should reach fromwards into the community. Swift access to expert diagnosis and

treatment improves outcomes for patients and can result in

long-term savings. Supporting patients to recover and manage

their conditions must be a priority in all policies.

There’s no such thing as ‘out-of-hours’ for my condition.I just want the right care for me, in the right place, atthe right time. Patient

We call on the next government to adoptthe Future Hospital model as a template forservice redesign:

> Remove barriers to specialist careRemove barriers to timely access to specialist diagnosis and

treatment. Disincentives to prompt referral or the delivery of

specialist medical care outside the hospital building must be

removed. Patients who need specialist medical care should

get it promptly: delays in access to expert, specialist care harm

patients. Such delays can lead to failure to recognise worsening

asthma causing death, or delayed care of diabetic foot diseaseleading to amputation.

80% of physicians think specialist medical teams have arole in delivering care beyond traditional hospital settings.10

Royal College of Physicians

> Focus on patient experience, recovery and self-managementMake recovery and self-management a priority in all policies,

and drive improvement in patient experience. Rehabilitation,

reablement, recovery, self-management and patient

experience should be a shared priority for all health and care

services. Barriers to patients leaving hospital promptly, with

support, must be removed. Good practice should be shared at

national level and promoted in national policy.

> Care for patients who are dyingCommit to national action to support improvements in

end-of-life care. It is the core responsibility of hospitals to

deliver high-quality care for patients in their final days of life

and appropriate support to their families, carers and those

close to them. There should be national action to improve the

evidence base around recognition of dying, hydration and

nutrition, symptom control, and communication.25 Clinical

audits to ensure continued improvement in the care of dying

patients should be supported and promoted at national level.

The provision of care for the dying should be monitored by

national quality regulators, like the Care Quality Commission.

5 Adopt the Future Hospital modelas a template for service redesign


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Realise the future hospital In brief

In September 2013 the Future Hospital Commission, set up

by the RCP, set out a radical new vision for the future of healthservices.2 The Future Hospital model aims to deliver:

• high-quality, 7-day care for all who need it • expert coordination of care for patients with a range of

medical and support needs

• rapid access to specialist care when it’s needed • continuity of care for all patients, including when they

enter or leave hospital

• strong teams that provide effective, compassionate care,and support and develop staff

• good relationships between teams working across healthand social care.

How will the future hospital work?

Care will come to patients, when and where they need it.

Teams from across health and social care will work together to

coordinate care around patients’ medical and support needs.

Teams that care for people with a medical illness will come

together within the hospital – from the emergency department

and acute and intensive care beds, through to general and

specialist wards. This won’t stop at the hospital door: specialist

medical teams will work closely with GPs, mental health and

social care teams. Specialist medical care will not be limited

to patients in labelled specialist wards or those admitted

to hospital. Medical teams will spend time working into thecommunity; primary and social care teams will have greater

involvement when patients are in hospital. By supporting each

other, professionals will be better able to support patients.

Patients will be swiftly assessed and supported to recover,

in hospital and at home. Patients will be reviewed by a senior

doctor as soon as possible when they arrive in hospital. This will

help patients return home on the same day if they don’t need

to stay in hospital (with ongoing support if they need it) or move

swiftly to the best bed for them. Patients who are in hospital

will be moved between beds and wards as little as possible.

Care for patients with multiple conditions will be coordinated

by a named doctor, who will pull in other teams when they’re

needed. Health professionals will be supported to reflect on theirown performance, focus on helping patients to recover, and

empower patients to make informed decisions about their care.

Patient experience will be valued as highly as clinical outcome.

Management structures will focus on coordination of care,

patient experience and recovery. A senior doctor will take lead

responsibility for making sure hospitals deliver this coordinated

approach to care. Teams will work to common goals, shared

outcomes, and in the interest of patients. Teams will be

supported by financial and management structures that make

working together easier than working apart. The information we

keep about patients’ needs will be based on common standards

so it can be better accessed and understood by both patients

and the professionals who support them. Patients with more

than one complex or lifelong condition – including frail older

people – will be at the centre of medical training.

How can we make the future

hospital a reality?There will not be a one-size-fits-all model across communities.

The Future Hospital model provides a template for local service

design. Patients, professionals, local leaders and communities

will come together to adapt the model so it meets their needs

and circumstances. The RCP is now working with individual

hospitals, their local health partners and patients to put the

Future Hospital model into practice. As this work progresses,

we will need national and local action and support to promote

change and remove barriers to delivering this innovative,

patient-centred model of care.

How can politiciansand government help?

> Commit to the Future Hospital model in manifestos andthe first days of government.

> Promote the Future Hospital model as a template for healthservice redesign.

> Talk to local health and social care services about howthey are embedding Future Hospital principles.

> Work with us to remove barriers to delivering the

future hospital.

> Help us share good practice from Future Hospital partnersacross the UK.

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How can the RCP help?Setting standards for clinical care and health services

Improving patient care – The RCP has a long history of mobilising

its member doctors to improve care for patients. We set standardsfor a wide range of medical services, and work directly with

healthcare teams to improve the quality of care they provide for

patients. From our innovative clinical audits to recent ground-

breaking reports on asthma and end-of-life care, all our work is

based on evidence and driven by what patients need. Patients

are involved in all our work. They help us develop expert guidance

on topics from patient experience and shared decision-making,

to standards for patient records. Through our Future Hospital

Programme, we are driving changes to the way the health service

is organised, nationally and locally. Our network of 30,000

members allows us not just to lead debate, but to change the way

healthcare is delivered on the ground.

Delivering education and training

Developing and supporting doctors – The UK has one of the

best systems of education and training in the world, with the

RCP at its forefront. Our focus on excellence in education helps

physicians to deliver the highest standards of patient care. We

work collaboratively to set the curriculum for specialist doctors in

training, and assess them to make sure they are able to provide the

care that patients deserve. We support doctors to lead and to share

their knowledge with the next generation of doctors. We provide

leadership to the medical profession, working with our members

and patients to define what it means to be a good doctor.

Public health and researchLeading to improve health – Drawing on the expertise of leaders

in their field, the RCP offers evidence-based recommendations

for addressing the major public health challenges we face. Our

ambition is to support people to lead healthier lives – whether

through our coordination of the Alcohol Health Alliance, the

knowledge of our Tobacco Advisory Group, or influential reports

on obesity and health inequalities. We also promote research, so

that the next generation of patients has access to innovative new

treatments.

The RCP can provide expert advice to government, national

organisations and policymakers. If you would like more

information on any of our work, email [email protected]

2015 Challenge

The RCP is a member of the 2015 Challenge, a partnership

of national organisations representing health and care charities,

local government, communities, staff and leaders, speaking

with one voice.

References

1 Alzheimer’s Society : Dementia 2013, infographic . www.alzheimers.org.uk/infographic[Accessed: 14 August 2014]

2 Future Hospital Commission. Future hospital: Caring for medical patients. London: RCP, 2013.

3 Find out more about the Future Hospital model at: www.rcplondon.ac.uk/futurehospital

4 House of Commons Health Committee. Managing the care of people with long termconditions. London: The Stationary Office, 2014.

5 Health and Social Care Act 2012. Duty as to promoting integration: ClinicalCommissioning Groups, Part 1, section 26 (14Z1); NHS Commissioning Board, Part 1,section 23 (13N). General duties: Monitor, section 62 (4)

6 Future Hospital Commission. Future hospital: Caring for medical patients. London: RCP,2013. Page 18.

7 King’s Fund. The NHS productivity challenge: experience from the front line. London:King’s Fund, 2014.

8 Commonwealt h Fund, 2014. www.commonwealthfund.org/publications/fund-reports/2014/jun/mirror-mirror [Accessed 25 July 2014]

9 NHS England. The NHS belongs to the people: a call to action. London: NHS England, 2014.

10 Royal College of Physicians. Results, research panel survey – July 2014. London: RCP,2014. (Unpublished.)

11 Health and Social Care Act 2012. Duty as to education and training: Secretary of State,Part 1, section 7 (1F). Duty as to promoting education and training: NHS CommissioningBoard, section 23 (13M); Clinical Commissioning Groups, section 26 (14Z).

12 Does NHS staff wellbeing affect patients’ experience of care? Nursing Times 2013;109:16–17.

13 Sergeant J, Laws-Chapman C. Creating a positive workplace culture.NursingManagement 2012;18:14–19.

14 Department of Health.NHS health and well-being: interim report. London: DH, 2009.

15 Department of Health.NHS health and well-being: final report. London: DH, 2009.

16 King’s Fund. Never again? The story of the Health and Social Care Act 2012. London:King’s Fund, 2012.

17 The Marmot Review. Fair Society, Healthy Lives: The Marmot review. London: TheMarmot Review, 2010.

18 Royal College of Physicians. Passive smoking and children: a report of the Tobacco Advisory Group of the Royal College of Physicians. London: RCP, 2010.

19 University of Sheffield, 2013. www.sheffield.ac.uk/polopoly_fs/1.291621!/file/julyreport.pdf [Accessed 19 August 2014]

20 University of Stirling. Health First: An evidence based alcohol strategy for the UK. University of Stirling: 2013.

21 National Heart Forum.Consultation response on front of pack nutrition labelling. London:NHF, 2012.

22 Foresight. Tackling obesities: future choices. Project report. London: Foresight, 2007.

23 Information Centre. Health Survey for England 2006. London: Information Centre, 2008.

24 NHS Outcomes Framework – Domain 2: Enhancing quality of life for people with longterm conditions. www.england.nhs.uk/resources/resources-for-ccgs/out-frwrk/dom-2/[Accessed 14 August 2014]

25 Royal College of Physicians. National care of the dying audit for hospitals, England:National report. London: RCP, 2014.

Get involvedThe RCP will continue to develop the themes inFuture hospital: More than a building in the run

up to the UK general election in 2015.

To find out more, visit

www.rcplondon.ac.uk/morethanabuilding

To tell us what you think –

or request more information – email us [email protected]

Documents

Future Hospital - More Than a Building